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    Suggest treatment for chest discomfort

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Posted on Fri, 5 May 2017 in Lung and Chest disorders
Question: Hi
i have chest and stomach in left side of the chest discomfort and i already did x ray, radiology two times, stress test, ECHO test and blood test, EKG . the cardiology want do CT coronary ango .
is radiology the same as CT coronary ango ?
and i am concern to about the radiation that i already exposed from these tests and they may cause a cancer . should i do CT coronary ango?
thanks
doctor
Answered by Dr. Jnikolla 43 minutes later
Brief Answer:
Please do the CT coronary angio

Detailed Answer:
Hello and thank you for asking in HCM

I can understand your concern

According to the history you provide this kind of pain should be examined further.

I fully agree that you have to do CT coronary angio.
This is a radiology test too but it is more specified to evaluate better the coronary arteries.

Do not worry about the radiation.

The risk of going cancer during lifetime from radiation is low.

So in my opinion it is more important now to do this examination.

Do not worry

Dr.Jolanda


Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Jnikolla 1 hour later
Thank you
But why i need to do this test because i already did many tests and were all normal, and when i do sport i don't feel any pain, i feel the pressure at rest
The pain is like pressure, tightens and in the middle of the chest some times i feel it under the left breast.
do you think i have heart problem . and also i heard that CT radiation is more 50 times than x ray radiation . and i already exposed to 30msv with previous tests
these link show the risks for ct radiation's , please check them
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/
http://www.health.harvard.edu/heart-health/radiation-from-ct-other-cardiac-tests-can-be-a-problem
doctor
Answered by Dr. Jnikolla 1 hour later
Brief Answer:
You can do prior fibrogastroscopy

Detailed Answer:
Hi again

If the chest X ray is normal ,lung problems are excluded.

IN my experience in patients like your pain we preceded for sure with CT angio.

Or another step before doing it is fibrogastroscopy for excluding gastric problems.
Sometimes stomach problems may cause pain like you prescribe

If this examination come negative than you MUST do CT angio to evaluate heart and its vessels.

When clinical picture is clear for heart diseases its not so important the radiation compare to the secure life of the patient

If you want you can attach me the results and i am here to help you


Take care

Dr.Jolanda
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Jnikolla 10 hours later
thanks
the general doctor sent me to cardiology and cardiology gave me OMEPRAZOLE but didn't help. i feel the pain some time under the chest on left side of the lung. i can send u the ER report but i don't have another report for stress , ECHO test. i am not sure if i do CT angio because if i do it i will expose to 45 mvs radiation when i did stews test, x ray, radiology two time. i think this pain not from the heart because if from the heart i couldn't ride a stair or do sport, what do you think ?
doctor
Answered by Dr. Jnikolla 4 hours later
Brief Answer:
You have to do it unfortunately

Detailed Answer:
Hi again

In my opinion you should do CT angio, i am sorry but i am a doctor and i think like other doctors for your situation.

Please do it don't be afraid from the radiation .It does not make sense.

Wishes

Dr.Jolanda
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Jnikolla 16 minutes later
thanks
but another doctor here said CT angio test not suitable let for this kind of pain, let me post his message "Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

Regarding your concern, I would explain that as you have a normal cardiac ultrasound and a normal nuclear perfusional cardiac stress test, there is no any need to perform a coronary angio CT.

As your clinical symptomatology is non specific for coronary artery disease (the pain is more pronounced at rest than during physical exertion, it has a migrating nature), and your nuclear stress test has resulted normal, the probability for the pain to be due to cardiac ischemia is quite unlikely.

Furthermore, you are right about the cumulative radiation exposure. Coronary angio CT uses a high resolution imagine and hence a very dense multi-slice scanning.

This means that radiation is considerable and could not be justified considering the fact that you have not an intermediate pretest probability for coronary artery disease (which is in fact the ideal situation for undergoing coronary angio CT).

In my personal professional opinion, coronary angio CT would not be the suitable medical test for evaluating the nature of your chest pain, which seems in fact to be of extra-cardiac origin.

Hope you will find this answer helpful!

In case of any further uncertainties, do not hesitate to ask me again.

Kind regards,"

he doesn't also recommend me to do it

it show that he is cardiology too
doctor
Answered by Dr. Jnikolla 25 minutes later
Brief Answer:
We should follow the guidelines

Detailed Answer:
Hi

In my personal opinion from my clinical view and if we should follow the guidelines for chest pain the last test to exclude the cardiac origin of the pain is CT angio.

However the decision its upon to you and your treating doctor.

Take care

Dr.Jolanda
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Jnikolla 1 hour later
thanks
I agree with you, but how about the CT radiation . i am concern to get cancer in long term because it will be 45 mSv ,

and if i have cardiac origin issue, they would know in previous test . is in't it?
doctor
Answered by Dr. Jnikolla 6 minutes later
Brief Answer:
no conclusion

Detailed Answer:
Hi

Do not worry about the radiation in the your case you need that CT.

Previous tests has concluded in no conclusion till now.

Dr.Jolanda
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
Answered by
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Dr. Jnikolla

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